Coronary events and inflammation.

Česká verzia

Authors: V. Staněk
Authors place of work: Klinika kardiologie IKEM, Praha
Published in the journal: Kardiol Rev Int Med 2009, 11(3): 139-142
Category: Nontraditional risk factors cardiovascular disease

Summary

Traditionally, identification of persons in risk of myocardial infarction is based on the evaluation of the established risk factors, i.e. smoking, hypertension, hyperlipidaemia and diabetes. However, half of the patients with myocardial infarction have a maximum of one risk factor and there is an urge to further specify the risk of an event. At present, atherosclerosis, development of an atheroma as well as development of plate rupture are considered to be inflammatory processes. Activated immune cells produce cytokines that are detectable either directly from blood or as systemic manifestations. These indicators, inflammation markers, are now identified as other risk factors of a coronary or cerebral event. Of all these biomarkers, C‑reactive protein (high‑sensitivity CRP – hs CRP) and lipoprotein‑associated phospholipase (Lp/PLA₂) are most researched. The presence of these inflammatory biomarkers increases the risk evaluated with the traditional risk factors about two‑fold. Even though the current guidelines do not include these biomarkers in the risk calculation, evidence exists suggesting that higher values of these biomarkers might represent an indication for an intensive hypolipidemic therapy even in situations when this would not be indicated based on the traditional risk calculation. Monitoring of the inflammatory markers represents a move from the traditional risk identification to identification of activation of vascular inflammatory processes; the move from identification of exercise‑induced myocardial ischemia to identification of vulnerable plates and a vulnerable patient.

Keywords:
atherosclerosis – risk factors – vulnerable plate – C‑reactive protein – lipoprotein‑associated phospholipase A₂

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